These medicines are different in a few ways that may play a role in your decision. Your health also plays a role in which medicine is best for you. Your doctor can help you understand the benefits and risks of each medicine based on your health.
You can't take apixaban, dabigatran, or rivaroxaban if you have heart valve disease, an artificial heart valve, or severe kidney or liver disease.8 You can likely take warfarin if you have one or more of these conditions.
Warfarin has been used for many years to reduce the risk of stroke in people who have atrial fibrillation. The medicine is low-cost, and doctors understand its long-term effects.
Apixaban, dabigatran, and rivaroxaban are newer anticoagulants. Their long-term effects aren't known.
Risk of bleeding in the brain
All anticoagulants have a risk of causing bleeding in different parts of the body, including the brain. Bleeding in the brain is very serious. Compared with warfarin, the newer anticoagulants have a lower risk of causing bleeding in the brain.
About 6 out of 1000 people who take a newer anticoagulant will have bleeding in the brain. This means that 994 out of 1000 people will not have this bleeding problem. About 12 out of 1000 people who take warfarin will have bleeding in the brain. This means that 988 out of 1000 people will not have this bleeding problem.7
Blood tests and vitamin K monitoring
When you take warfarin, you'll need to get regular blood tests to make sure you are taking the right dose. And you will need to watch how much vitamin K you eat and drink.
When you take a different type of anticoagulant, you don't need to have regular blood tests to check if you are taking the right dose and you don't need to watch your vitamin K intake.
Warfarin costs less than the other anticoagulants. Warfarin costs about $48 for a 1-year supply. Apixaban, dabigatran, and rivaroxaban can cost about $3,000 for a 1-year supply.9 If you have health insurance, some or all of this cost may be covered.
If you have a bleeding problem or need surgery right away, your doctor may need to quickly reverse the effects of an anticoagulant.
Warfarin. Doctors know how to quickly reverse the effects of warfarin to stop or prevent bleeding.
Anticoagulants other than warfarin. Doctors do not have a medicine that has been proved to quickly reverse the effects of these anticoagulants.